Care Approach Toward Dementia Among The Nursing Staff In Long-term Care Facilities: A Mixed Study

Objective:1.To understand the current situation of care approach toward dementia and analyse the influencing factors of care approach toward dementia among the nursing staff in longterm care facilities(LTCFs),in order to provide preliminary basis for developing personcentered dementia care for nursing staff in LTCFs.2.To understand the dilemma and true inner feelings of the nursing staff in LTCFs when providing person-centered care for people with dementia,further explore the influencing factors of care approach toward dementia among the nursing staff,and provide theoretical basis for the in-depth implementation of person-centered dementia care in LTCFs.3.To explore the effect of the online dementia care education on nursing staff’dementia care approach,dementia knowledge,attitude,confidence and empathy ability,in order to provide reference and suggestions for nursing staff’ dementia education in LTCFs in the future.Methods:The mixed method was used to design the study.The first part was a quantitative study.A convenient sampling method was adopted to select 323 nursing staff from 15 LTCFs in Shandong Province as the research objects from January to March 2022.The general questionnaire,Approach to Advanced Dementia Care Questionnaire(ADCQ),Dementia Knowledge Assessment Tool Version 2(DKAT 2),Dementia Attitudes Scale(DAS),Confidence in Dementia Scale(CODE),and the Jefferson Scale of Empathy Health Professionals(JSE-HP)were used to conduct the survey.The second part was a descriptive qualitative study.Objective sampling method and maximum difference sampling strategy were adopted to select 13 nursing staff who participated the cross-sectional study as research objects from 3 LTCFs in Jinan,Shandong Province from March to April 2022.Data were collected by semi-structured,in-depth individual online interviews.With the assistance of qualitative analysis software NVivo11,qualitative content analysis was applied to analyze the data.The third part was a pre-and-post self control study.From June to July 2022,80 nursing staff in LTCFs from the cross-sectional study were randomly selected for online dementia care education intervention.Levels of ADCQ,DKAT 2,DAS,CODE and JSE-HP were measured among the nursing staff after the intervention.The database was established and IBM SPSS Statistics 25.0 statistical software was used for data analysis.Results:1.323 questionnaires were distributed in the cross-sectional study,of which 317 were valid,with an effective rate of 98.14%.The time of filling out the questionnaire ranged from15 to 30 minutes.13 nursing staff in LTCFs were interviewed in the qualitative study.In the pre-and-post self control study,80 participants were involved,and 7 participants of them were lost to follow-up with a lost follow-up rate of 8.75%.Finally,73 of them completed the online dementia care education.2.The score of ADCQ,DKAT 2,DAS,CODE and JSE-HP was(6.21±1.96),(14.90±2.91),(100.57±17.52),(28.77±8.98)and(106.37±15.28)respectively among nursing staff in LTCFs.3.The results of univariate analysis showed that the education level(P=0.000),years of nursing work(P=0.044),marital status(P=0.002),time spent caring for people with dementia(P=0.000)and dementia education and training experience(P=0.001)had significant effects on dementia care approach among nursing staff in LTCFs(P<0.05).4.There were weak correlations between dementia care approach and age and empathy ability(r=0.184、0.125,P<0.05),and moderate correlations between dementia care approach and dementia knowledge and confidence in dementia(r=0.365、0.401,P<0.05)among nursing staff in LTCFs.5.The results of multivariate analysis showed that the age,dementia education and training experience,dementia knowledge,confidence in dementia and empathy ability were important factors affecting the dementia care approach among nursing staff in LTCFs(P=0.000,0.034,0.005,0.000,0.015,P<0.05).6.The qualitative interviews showed that the nursing staff faced the dilemmas of unmet needs and insufficient supportive care for people with dementia,inadequate dementia care knowledge and skills and teamwork atmosphere for nursing staff and the imperfect dementia care resources,environment and the lack of person-centered dementia care standards for institution when they implemented person-centered dementia care in LTCFs.7.After participating in the online dementia care education intervention,nursing staff’score in ADCQ(6.84±1.57),DKAT 2(15.58±1.89),DAS(109.03±14.46)and CODE(29.44±6.78)were respectively higher than that of before with statistically significant differences(P<0.05).Conclusions:1.The person-centered dementia care approach of nursing staff was at lowly moderate level,the attitude was at highly intermediate level,and the dementia knowledge,confidence and empathy ability were at medium levels.2.The level of person-centered care approach was positively associated with age,dementia knowledge,confidence and empathy ability among nursing staff in LTCFs.3.The age,dementia education and training experience,dementia knowledge,confidence and empathy ability were the main influencing factors of person-centered dementia care approach among nursing staff in LTCFs.4.Some of the influencing factors came from people with dementia,nursing staff themselves,and institutional care environment for nursing staff to conduct person-centered dementia care in LTCFs.Above these factors supplemented the findings of quantitative study.Meeting the needs and preferences of people with dementia,enhancing nursing staff’knowledge,skills and atmosphere of teamwork,and optimizing person-centered approach such as institutional care resources,environment and assessment standards are beneficial for nursing staff to promote person-centered dementia care practice.5.As for nursing staff in LTCFs,online dementia care education intervention could effectively promote their implementation of person-centered dementia care,increase their dementia knowledge,improve their attitude towards people with dementia,and enhance their confidence in dementia.Online dementia care education provided a time-saving,efficient and convenient way to learning for nursing staff in LTCFs,avoided the disadvantages of traditional education limited by time and place,and could help learners to fulfill independent learning and mobile learning,and be worthy of further promotion and application.